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4 November 2013

It Makes (No) Sense

I ask of you to make an exercise
of imagination and think that you are a medical doctor in the city of Vienna at
one of the world’s best hospitals. You are a true gentleman, member of an elite
profession with outstanding education and highly respected by the entire
society. You have spent many years learning medicine and you exercise your
profession in good faith, doing what you know is best for your patients. You
strive to fulfill your duties to the best of your capabilities. Your goal is to
make people healthy again and, if the case, save their lives. Despite of your
best efforts, some of your patients die. You think that this is the way of nature and even God’s will. After all, not everyone can
be saved even if you apply the best of your knowledge in medicine.

The year is 1849 and Vienna is the
capital of one of the world’s most powerful empires. Naturally, the hospital in
Vienna has the best physicians in (central) Europe. Many smart and highly
educated people are practicing the noble science of medicine. However, there
are some diseases that can’t be cured and one of them is childbed fever which kills many women very soon after they gave
birth. Despite the fact that the women who gave birth in this world-class
hospital benefited from the care of some of the best doctors of the time, many
of them (up to one third) die soon after their children were born. This must be
the will of God or just nature’s way, since even the best
doctors in the empire can’t help the new mothers. Certainly this condition - childbed fever – is caused by something
that is beyond human understanding. It must have some cosmic origins.

If you detect something that is
not quite as it should be, do not forget that it is the year 1849.

One of your colleagues, a fellow
doctor, who works in one of the maternity units of the hospital, has a wacky
idea that childbed fever can be
prevented. This is a bit awkward since the condition is known to be the way of nature,
the price that nature sometimes asks
for bringing a new life into the world. This weird doctor is Ignaz Philipp
Semmelweis. He made the students and trainee doctors who are under his
supervision to perform an unusual activity in the middle of their daily
routine. Usually, doctors, students and trainee doctors would work on the cadavers
in the basement of the hospital. (Cadavers were, and still are, used for
teaching and research purposes). Afterwards they would perform their work with
(living) patients. The wacky doctor Ignaz Philipp Semmelweis asked his students
and trainee doctors to do something very unusual and that made absolutely no sense exactly after finishing the work with the
cadavers and just before starting their patient duties. He asked them to wash their
hands (with chlorinated lime solutions). The students and trainee doctors were
surprised by the unusual request. They couldn’t understand why doctor Semmelweis
would ask them to do this since it made
absolutely no sense. (Remember, the year is 1849). Some of the trainee
doctors complained to the hospital’s management and an investigation was
launched since the wacky doctor has created a new protocol and established new
rules without the express approval of the management.

Doctor Semmelweis told the
hospital’s management board that he noticed that when he washed his hands
before working with the women in the maternity, the number of women who got childbed fever decreased dramatically
from about 30% to about 1%. He also said that he asked his students and trainee
doctors to do the same and that this rule of washing hands before working with
patients should be introduced to the entire hospital.

The board wasn’t very happy with
this outrageous suggestion and asked doctor Semmelweis to give an explanation.
The doctor could only say that cadaveric
particles on the doctors’ hands would cause blood poisoning to the women in the maternity. This made no sense
to the doctors in the hospital management, since doctors by their very nature
could not have dirty hands as factory workers and farmers had. They were true
gentlemen. How could they be the cause of a disease which is due to cosmic
influences? Clearly doctor Semmelweis is not in his right mind anymore.

Let’s leave the mid-nineteenth
century Vienna and come back to today.

For you it makes no sense that for the doctors in the board of the hospital
it made no sense to wash their hands
before working with (live) patients. This is because you know that bacteria
exist. You have the notion of bacteria and of micro-biology. The doctors in
those days didn’t have these notions. For them such things simply didn’t exist
and naturally since they didn’t exist they can’t cause childbed fever or any other disease.

This was true also for doctor Ignaz
Philipp Semmelweis. He had no notion of bacteria or micro-biology; he used the
term of cadaveric particles. 1849 was
twenty years before the recognition of Louis Pasteur’s work on micro-biology
and its applications in medicine.

The doctors in the board of the
Vienna Hospital were acting to the best
of their knowledge. Can you blame them for not knowing something that wasn’t
known by anyone? For them, it actually
made no sense to wash their hands since they did not know that bacteria (on
their hands) existed. The (only) reasonable explanation was that Ignaz Philipp
Semmelweis has gone crazy.

In fact, Ignaz Philipp Semmelweis
was fired from the hospital in Vienna and soon after was committed into a mental
asylum where, fourteen days later he was beaten to death by the guards. Ignaz
Philipp Semmelweis died being considered mad, with shame instead of glory. Only
twenty years after his death his work received the proper merit.

Earlier I said that the doctors
on the board of the Vienna Hospital can’t be blamed for not knowing something
that was not known by anyone. What they can be blamed for is: not knowing that
there are things they don’t know. They can be blamed for holding too firmly to
their existing beliefs and giving too much credit to the mystic explanation.
They can be blamed for not accepting that they are not omniscient, that they
didn’t accept that they can make mistakes or simply hold invalid opinions. They
can be blamed for Ignaz Philipp Semmelweis dyeing in disgrace, but most
importantly they are to be blamed for all the women who died from childbed fever in between the time that
they rejected Semmelweis’s proposition and the time it was finally accepted
that washing hands before working with patients makes sense.

The story of Ignaz Philipp
Semmelweis is a sad and bitter one. His story tells us that we should know that
there are many things we don’t know. His story tells us that it may very well
be the case that what we think makes no
sense, in fact, makes all the sense
in the world once you add a bit of (missing) knowledge.

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Nick NAUMOF

Nick Naumof has studied people from different scientific perspectives ranging from economics to consumer behavior, behavioral economics and evolutionary psychology.
Author of “It Makes (No) Sense – In Between the Joy of Gaining and the Fear of Losing”, Nick Naumof has a unique mix of skills that allow him to translate the academic insights of behavioral science into practical applications in business and service design.
With more than seven years’ experience in developing and delivering workshops and training programs, Nick Naumof offers highly engaging and intriguing learning experiences.